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pandora necklaces The reported mean or median age of the included patients ranged from 5429 to 71 years41 (with the exception of the study by Bahrmann et al,23 which included only patients aged 70 years or over), and the proportion of men ranged from 49%23 to 83%.39 One study included only patients with coronary artery disease,39 and another included unselected patients aged 70 or over presenting to the emergency department with a non surgical condition.23 Ten studies defined specific time from onset of symptoms to presentation as an inclusion criterion, which ranged from four hours39 to 24 hours.5 Most of the patients presented to the emergency department within 12 hours of symptom onset, with study medians ranging from 3.5 hours5 to 6.3 hours,21 22 but the average time was reported inconsistently. In 11 papers, the results for non ST elevation myocardial infarction were reported separately or patients with ST elevation on the initial electrocardiogram were excluded from the study. The median prevalence of acute myocardial infarction was 21.4% (interquartile range 13.3 34.7%) and ranged from 8.0%29 to 56.2%.42All included studies used a composite reference standard based on the contemporary universal definition of myocardial infarction.12 In terms of reference assays used to diagnose myocardial necrosis, eight studies used serial high sensitivity troponin T assay; 13 studies used standard troponin T or I assays, or a combination of them; one study used a combination of either standard troponin T or I (local assays) and high sensitivity troponin I assays (central laboratory)29; one study used a combination of standard and high sensitivity troponin T assays41; and the reference assay in one study was unclear36 (in some studies the accuracies according to different reference assays were reported separately).Twenty studies reported the performance of high sensitivity troponin T at the manufacturer’s recommended cut off value of 14 ng/L, which represents the 99th centile of a healthy reference population5 20 21 23 28 29 30 31 32 34 35 36 37 39 41 42 45 54 55 56; four studies reported the performance of the test at 3 ng/L (limit of blank)5 22 28 43 and four at 5 ng/L (limit of detection)19 22 34 53; results for receiver operating characteristics optimised or other cut off values were also reported in some papers (table 1 and supplementary table C).Table 2 and supplementary table D show the results from the assessment of the methodological quality of the included studies pandora necklaces.